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Feldman DE, Orozco T, Bernatsky S, Desmeules F, El-Khoury J, Laliberté M, Légaré J, Perreault K, Woodhouse L, Zummer M. Do physical therapists follow evidence-based practices for treatment of inflammatory arthritis? Results from an online survey. Physiother Theory Pract 2024; 40:637-646. [PMID: 36238986 DOI: 10.1080/09593985.2022.2135150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Physical therapists (PTs) should know how to best treat patients with inflammatory arthritis. OBJECTIVE To document interventions chosen by PTs for patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and whether choices follow evidence-based practice. METHODS Licensed musculoskeletal PTs in Quebec, Canada responded to an online survey. Descriptive statistics illustrated proportions for each treatment choice and inferential statistics explored associations with demographic and practice-related factors. RESULTS There were 298 PTs who responded to the survey. For both RA and AS respectively, most common interventions were mobility exercises (91.0%; 98.3%) and patient education (90.1%; 92.8%). For both cases, slightly >60% selected strengthening exercises. Passive forms of therapy were chosen by 36% of PTs for RA and 58% for AS. Aerobic exercise was rarely selected. PTs working in the public sector were less likely to use manual therapy for both RA (Odds Ratio (OR) 0.43, 95% confidence interval (CI) 0.22,0.86) and AS (OR 0.46, 95% CI 0.22,0.97). CONCLUSIONS Most PTs chose mobility exercises and patient education, representing evidence-based approaches. Despite current recommendations, strengthening and especially aerobic exercises were not used as much. There is a need to increase awareness regarding the benefits of strengthening and aerobic exercise for these patients.
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Affiliation(s)
- Debbie Ehrmann Feldman
- Physiotherapy Program, Université de Montréal École de Readaptation, Pavillon 7077 Avenue du Parc, C.P. 6128, Succ. Centre-Ville, H3C 3J7, Montreal, Qc, Canada
- Centre for Interdisciplinary Research in Rehabilitation, 6363, Hudson Road, Office 061, Lindsay Pavilion of the IURDPM, H3S 1M9, Montreal, QC, Canada
- Center for Public Health Research, Université de Montréal, 7101 Av du Parc, H3N 1X9, Montréal, QC, Canada
| | - Tatiana Orozco
- Physiotherapy Program, Université de Montréal École de Readaptation, Pavillon 7077 Avenue du Parc, C.P. 6128, Succ. Centre-Ville, H3C 3J7, Montreal, Qc, Canada
| | - Sasha Bernatsky
- McGill University Department of Rheumatology and Clinical Epidemiology, McGill University Health Centre, 5252 de Maisonneuve O, H4A3S5, Montreal Qc, Canada
| | - François Desmeules
- Physiotherapy Program, Université de Montréal École de Readaptation, Pavillon 7077 Avenue du Parc, C.P. 6128, Succ. Centre-Ville, H3C 3J7, Montreal, Qc, Canada
- Research Institute of Hôpital Maisonneuve , Rosemont 5451 de l'Assomption, H1T2M4, Montreal, Qc, Canada
| | - Jonathan El-Khoury
- Université de Sherbrooke et Université du Québec à Chicoutimi Programme de Formation Médicale à Saguenay, Pavillon du Grand Séminaire, 555 Boul de l'Université, G7H2B1, Chicoutim Qc, Canada
| | - Maude Laliberté
- Physiotherapy Program, Université de Montréal École de Readaptation, Pavillon 7077 Avenue du Parc, C.P. 6128, Succ. Centre-Ville, H3C 3J7, Montreal, Qc, Canada
| | - Jean Légaré
- Patients Intéressés par la Recherche en Arthrite, CHU de Québec Université Laval, Arthritis Research, Qc, Canada
| | - Kadija Perreault
- School of Rehabilitation, Université Laval; Center for Interdisciplinary Research in Rehabilitation and Social Integration, 525 Bd Wilfrid-Hamel bureau H-1300, G1M 2S8, Québec, QC, Canada
| | - Linda Woodhouse
- Tufts University School of Medicine Department of Public Health and Community Medicine Doctorate of Physical Therapy Program, 101 E. Washington St., Suite 950, 85004, Phoenix, AZ, USA
| | - Michel Zummer
- Université de Montréal and Hôpital Maisonneuve Rosemont 5451 de l'Assomption, H1T2M4, Montréal, Qc, Canada
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Orozco T, Feldman DE, Bernatsky S, Légaré J, Perreault K, Tawiah AK, Zummer M, Hudon A. Evaluating a new referral pathway from physical therapists to rheumatologists: A qualitative study. J Interprof Care 2022; 36:932-940. [DOI: 10.1080/13561820.2022.2044295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tatiana Orozco
- École de réadaptation, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Debbie Ehrmann Feldman
- School of Rehabilitation, Physiotherapy Program and School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation, Institute of Public Health Research, Université de Montréal, Montreal, QC, Canada
| | - Sasha Bernatsky
- McGill University division of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - Jean Légaré
- Patient Partner Member of Pira, Chu de Québec Université Laval, Arthritis Research, Canada
| | - Kadija Perreault
- School of Rehabilitation, Université Laval; Center for Interdisciplinary Research in Rehabilitation and Social Integration, QC, Canada
| | | | - Michel Zummer
- Université de Montréal and Hôpital Maisonneuve Rosemont, QC, Canada
| | - Anne Hudon
- School of Rehabilitation, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (Crir), Centre de Recherche En Éthique (Cré), Montreal, QC, Canada
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Michou L, Julien AS, Witteman HO, Légaré J, Ratelle L, Godbout A, Tardif J, Côté S, Boily G, Lui R, Ikic A, Trudeau J, Tremblay JL, Fortin I, Bessette L, Chetaille AL, Fortin PR. Measuring the impact of an educational intervention in rheumatoid arthritis: An open-label, randomized trial. Arch Rheumatol 2021; 37:169-179. [PMID: 36017212 PMCID: PMC9377171 DOI: 10.46497/archrheumatol.2022.8965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives
This study aims to determine whether patients with active rheumatoid arthritis (RA), either starting on or changing biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs), demonstrate better self-management safety skills three months after receiving a multidisciplinary educational intervention compared to patients receiving usual care. Patients and methods
Between October 2015 and October 2018 , this open-label, randomized-controlled trial included a total of 107 RA patients (27 males, 80 females; mean age: 60.2±10.4 years; range, 54 to 71 years) who were on treatment or in whom treatment was changed with a biological or targeted synthetic DMARD. The patients were randomized into two groups: Group 1 (n=57) received additional intervention with educational DVD and one teleconference session and Group 2 (n=55) received usual care and were offered the intervention at three months. All patients underwent a final visit at six months. At each visit, the patients completed the BioSecure questionnaire measuring the self-care safety skills, a behavioral intention questionnaire, and the Beliefs about Medicines Questionnaire (BMQ). Results
No significant difference was observed in the Biosecure score at three months between the two groups (p=0.08). After pooling the first three-month data in Group 1 and the last three-month data in Group 2, the mean score of the BioSecure questionnaire increased to 7.10±0.92 in the group receiving educational intervention (p<0.0001). This increase was maintained at six months in Group 2 (p=0.88). The rate of appropriate behavioral intention increased over time (76% at baseline and 85% at six months for both groups). There was no significant change in the BMQ (p=0.44 to 0.84). Conclusion
The development of an educational DVD followed by a teleconference seem to improve self-care safety skills of the patients in practical situations.
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Affiliation(s)
- Laëtitia Michou
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Anne-Sophie Julien
- Department of Mathematics and statistics, Université Laval, Québec (Québec) Canada
| | - Holly O. Witteman
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec (Québec) Canada
| | - Jean Légaré
- Arthritis Alliance of Canada, Québec (Québec) Canada
| | - Lucie Ratelle
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
| | - Alexandra Godbout
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
| | | | - Suzanne Côté
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | | | - Rebecca Lui
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Alena Ikic
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Judith Trudeau
- Department of Rheumatology, Hôtel-Dieu de Lévis, Lévis, (Québec) Canada
| | - Jean-Luc Tremblay
- Clinique de Rhumatologie du Centre du Québec, Trois-Rivières, (Québec) Canada
| | - Isabelle Fortin
- Centre de Rhumatologie de l’Est du Québec, Rimouski, (Québec) Canada
| | - Louis Bessette
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Anne-Laure Chetaille
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Paul R Fortin
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
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Ruel-Gagné S, Simonyan D, Légaré J, Bessette L, Fortin PR, Lacaille D, Dogba MJ, Michou L. Expectations and educational needs of rheumatologists, rheumatology fellows and patients in the field of precision medicine in Canada, a quantitative cross-sectional and descriptive study. BMC Rheumatol 2021; 5:52. [PMID: 34839831 PMCID: PMC8627786 DOI: 10.1186/s41927-021-00222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Precision medicine, as a personalized medicine approach based on biomarkers, is a booming field. In general, physicians and patients have a positive attitude toward precision medicine, but their knowledge and experience are limited. In this study, we aimed at assessing the expectations and educational needs for precision medicine among rheumatologists, rheumatology fellows and patients with rheumatic diseases in Canada. Methods We conducted two anonymous online surveys between June and August 2018, one with rheumatologists and fellows and one with patients assessing precision medicine expectations and educational needs. Descriptive statistics were performed. Results 45 rheumatologists, 6 fellows and 277 patients answered the survey. 78% of rheumatologists and fellows and 97.1% of patients would like to receive training on precision medicine. Most rheumatologists and fellows agreed that precision medicine tests are relevant to medical practice (73.5%) with benefits such as helping to determine prognosis (58.9%), diagnosis (79.4%) and avoid treatment toxicity (61.8%). They are less convinced of their usefulness in helping to choose the most effective treatment and to improve patient adherence (23.5%). Most patients were eager to take precision medicine tests that could predict disease prognosis (92.4%), treatment response (98.1%) or drug toxicity (93.4%), but they feared potential negative impacts like loss of insurability (62.2%) and high cost of the test (57.5%). Conclusions Our study showed that rheumatologists and patients in Canada are overall interested in getting additional precision medicine education. Indeed, while convinced of the potential benefits of precision medicine tests, most physicians don’t feel confident in their abilities and consider their training insufficient to incorporate them into clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00222-2.
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Affiliation(s)
- Sophie Ruel-Gagné
- Division of Rheumatology-R4774, Department of Medicine, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Quebec, QC, G1V 4G2, Canada
| | - David Simonyan
- Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
| | | | - Louis Bessette
- Division of Rheumatology-R4774, Department of Medicine, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Quebec, QC, G1V 4G2, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
| | - Paul R Fortin
- Division of Rheumatology-R4774, Department of Medicine, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Quebec, QC, G1V 4G2, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada
| | - Diane Lacaille
- Arthritis Research Canada, University of British Columbia, Vancouver, BC, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.,Centre de Recherche en Santé Durable VITAM, Quebec, Canada
| | - Laëtitia Michou
- Division of Rheumatology-R4774, Department of Medicine, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Quebec, QC, G1V 4G2, Canada. .,Centre de Recherche du CHU de Québec-Université Laval, Quebec, Canada.
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Abbasgholizadeh Rahimi S, Légaré F, Sharma G, Archambault P, Zomahoun HTV, Chandavong S, Rheault N, T Wong S, Langlois L, Couturier Y, Salmeron JL, Gagnon MP, Légaré J. Application of Artificial Intelligence in Community-Based Primary Health Care: Systematic Scoping Review and Critical Appraisal. J Med Internet Res 2021; 23:e29839. [PMID: 34477556 PMCID: PMC8449300 DOI: 10.2196/29839] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Research on the integration of artificial intelligence (AI) into community-based primary health care (CBPHC) has highlighted several advantages and disadvantages in practice regarding, for example, facilitating diagnosis and disease management, as well as doubts concerning the unintended harmful effects of this integration. However, there is a lack of evidence about a comprehensive knowledge synthesis that could shed light on AI systems tested or implemented in CBPHC. OBJECTIVE We intended to identify and evaluate published studies that have tested or implemented AI in CBPHC settings. METHODS We conducted a systematic scoping review informed by an earlier study and the Joanna Briggs Institute (JBI) scoping review framework and reported the findings according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Reviews) reporting guidelines. An information specialist performed a comprehensive search from the date of inception until February 2020, in seven bibliographic databases: Cochrane Library, MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceDirect, and IEEE Xplore. The selected studies considered all populations who provide and receive care in CBPHC settings, AI interventions that had been implemented, tested, or both, and assessed outcomes related to patients, health care providers, or CBPHC systems. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Two authors independently screened the titles and abstracts of the identified records, read the selected full texts, and extracted data from the included studies using a validated extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. A third reviewer also validated all the extracted data. RESULTS We retrieved 22,113 documents. After the removal of duplicates, 16,870 documents were screened, and 90 peer-reviewed publications met our inclusion criteria. Machine learning (ML) (41/90, 45%), natural language processing (NLP) (24/90, 27%), and expert systems (17/90, 19%) were the most commonly studied AI interventions. These were primarily implemented for diagnosis, detection, or surveillance purposes. Neural networks (ie, convolutional neural networks and abductive networks) demonstrated the highest accuracy, considering the given database for the given clinical task. The risk of bias in diagnosis or prognosis studies was the lowest in the participant category (4/49, 4%) and the highest in the outcome category (22/49, 45%). CONCLUSIONS We observed variabilities in reporting the participants, types of AI methods, analyses, and outcomes, and highlighted the large gap in the effective development and implementation of AI in CBPHC. Further studies are needed to efficiently guide the development and implementation of AI interventions in CBPHC settings.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Mila-Quebec AI Institute, Montreal, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Gauri Sharma
- Faculty of Engineering, Dayalbagh Educational Institute, Agra, India
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Herve Tchala Vignon Zomahoun
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Quebec SPOR-Support Unit, Quebec City, QC, Canada
| | - Sam Chandavong
- Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
| | - Nathalie Rheault
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Quebec SPOR-Support Unit, Quebec City, QC, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Center for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Lyse Langlois
- Department of Industrial Relations, Université Laval, Quebec City, QC, Canada.,OBVIA - Quebec International Observatory on the social impacts of AI and digital technology, Quebec City, QC, Canada
| | - Yves Couturier
- School of Social Work, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jose L Salmeron
- Department of Data Science, University Pablo de Olavide, Seville, Spain
| | | | - Jean Légaré
- Arthritis Alliance of Canada, Montreal, QC, Canada
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Alboom M, Browne A, Dagenais F, Noiseux N, Kieser T, Légaré J, Brown C, Kiaii B, Eikelboom J, Lamy A. PICK YOUR CONDUIT WISELY TO DECREASE GRAFT FAILURE AFTER CABG SURGERY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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7
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MacLeod J, Aguiar C, Chanyi S, Fowlow C, O'Brien A, Brown C, Pozeg Z, Légaré J, Hassan A. THE IMPACT OF ROTATIONAL THROMBOELASTOMETRY (ROTEM) ON IN-HOSPITAL OUTCOMES AND BLOOD PRODUCT UTILIZATION FOLLOWING CARDIAC SURGERY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Sarkar S, MacLeod J, Aguiar C, Hassan A, Brunt K, Légaré J. FRAILTY ASSESSMENT USING ESTABLISHED DATA REGISTRY IN CARDIAC SURGERY: DEFICIT BASED APPROACH AND IMPACT ON CLINICAL OUTCOMES. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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9
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Witteman HO, Chipenda Dansokho S, Colquhoun H, Fagerlin A, Giguere AMC, Glouberman S, Haslett L, Hoffman A, Ivers NM, Légaré F, Légaré J, Levin CA, Lopez K, Montori VM, Renaud JS, Sparling K, Stacey D, Volk RJ. Twelve Lessons Learned for Effective Research Partnerships Between Patients, Caregivers, Clinicians, Academic Researchers, and Other Stakeholders. J Gen Intern Med 2018; 33:558-562. [PMID: 29327211 PMCID: PMC5880766 DOI: 10.1007/s11606-017-4269-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/16/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
Abstract
Research increasingly means that patients, caregivers, health professionals, other stakeholders, and academic investigators work in partnership. This requires effective collaboration rooted in mutual respect, involvement of all participants, and good communication. Having conducted such partnered research over multiple projects, and having recently completed a project together funded by the Patient-Centered Outcomes Research Institute, we collaboratively developed a list of 12 lessons we have learned about how to ensure effective research partnerships. To foster a culture of mutual respect, hold early in-person meetings, with introductions focused on motivation, offer appropriate orientation for everyone, and maintain awareness of individual and project goals. To actively involve all team members, it is important to ensure sufficient funding for everyone's participation, to ask for and recognize diverse contributions, and to seek the input of quiet members. To facilitate good communication, teams should carefully consider labels, avoid jargon and acronyms, judiciously use homogeneous and heterogeneous subgroups, and keep progress visible. In offering pragmatic, actionable lessons we have learned through our separate and shared experiences, we hope to help foster more patient-centered research via productive and enjoyable research collaborations.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada.
- Office of Education and Continuing Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
- Laval University Research Institute for Primary Care and Health Services (CERSSPL-UL), Quebec City, QC, Canada.
- Research Centre of the CHU de Québec, Quebec City, QC, Canada.
| | - Selma Chipenda Dansokho
- Office of Education and Continuing Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
- Office of Education and Continuing Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada
- Quebec Centre for Excellence in Aging, St-Sacrement Hospital, Quebec City, QC, Canada
| | | | - Lynne Haslett
- East End Community Health Centre, Toronto, ON, Canada
| | - Aubri Hoffman
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Noah M Ivers
- Family Practice Health Centre and Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
- Laval University Research Institute for Primary Care and Health Services (CERSSPL-UL), Quebec City, QC, Canada
- Research Centre of the CHU de Québec, Quebec City, QC, Canada
| | - Jean Légaré
- Arthritis Alliance of Canada, Québec, Canada
| | - Carrie A Levin
- Informed Medical Decisions Foundation, Healthwise, Inc., Boston, MA, USA
| | | | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Jean-Sébastien Renaud
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
- Office of Education and Continuing Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Dugas M, Trottier MÈ, Chipenda Dansokho S, Vaisson G, Provencher T, Colquhoun H, Dogba MJ, Dupéré S, Fagerlin A, Giguere AMC, Haslett L, Hoffman AS, Ivers NM, Légaré F, Légaré J, Levin CA, Menear M, Renaud JS, Stacey D, Volk RJ, Witteman HO. Involving members of vulnerable populations in the development of patient decision aids: a mixed methods sequential explanatory study. BMC Med Inform Decis Mak 2017; 17:12. [PMID: 28103862 PMCID: PMC5244537 DOI: 10.1186/s12911-016-0399-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/15/2016] [Indexed: 04/26/2024] Open
Abstract
Background Patient decision aids aim to present evidence relevant to a health decision in understandable ways to support patients through the process of making evidence-informed, values-congruent health decisions. It is recommended that, when developing these tools, teams involve people who may ultimately use them. However, there is little empirical evidence about how best to undertake this involvement, particularly for specific populations of users such as vulnerable populations. Methods To describe and compare the development practices of research teams that did and did not specifically involve members of vulnerable populations in the development of patient decision aids, we conducted a secondary analysis of data from a systematic review about the development processes of patient decision aids. Then, to further explain our quantitative results, we conducted semi-structured telephone interviews with 10 teams: 6 that had specifically involved members of vulnerable populations and 4 that had not. Two independent analysts thematically coded transcribed interviews. Results Out of a total of 187 decision aid development projects, 30 (16%) specifically involved members of vulnerable populations. The specific involvement of members of vulnerable populations in the development process was associated with conducting informal needs assessment activities (73% vs. 40%, OR 2.96, 95% CI 1.18–7.99, P = .02) and recruiting participants through community-based organizations (40% vs. 11%, OR 3.48, 95% CI 1.23–9.83, P = .02). In interviews, all developers highlighted the importance, value and challenges of involving potential users. Interviews with developers whose projects had involved members of vulnerable populations suggested that informal needs assessment activities served to center the decision aid around users’ needs, to better avoid stigma, and to ensure that the topic truly matters to the community. Partnering with community-based organizations may facilitate relationships of trust and may also provide a non-threatening and accessible location for research activities. Conclusions There are a small number of key differences in the development processes for patient decision aids in which members of vulnerable populations were or were not specifically involved. Some of these practices may require additional time or resources. To address health inequities, researchers, communities and funders may need to increase awareness of these approaches and plan accordingly. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0399-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michèle Dugas
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Marie-Ève Trottier
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Selma Chipenda Dansokho
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Gratianne Vaisson
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Thierry Provencher
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Sophie Dupéré
- Faculty of Nursing, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Williams Building, Room 1C448, Salt Lake City, UT, 84132, USA
| | - Anik M C Giguere
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, Research Centre of the CHU de Quebec, St-Sacrement Hospital, 1050, chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada
| | - Lynne Haslett
- East End Community Health Centre, 1619 Queen Street East, Toronto, ON, M4L 1G4, Canada
| | - Aubri S Hoffman
- Department of Health Services Research, The MD Anderson Cancer Center, FCT9.5028, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Noah M Ivers
- Family Practice Health Centre, Institute for Health Systems Solutions and Virtual Care and Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S1B2, Canada.,Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Ave, Toronto, ON, M5G1V7, Canada
| | - France Légaré
- Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Jean Légaré
- Patient Partner, 403 rue des Érables, Neuville, Québec, G0A 2R0, Canada
| | - Carrie A Levin
- Healthwise, Incorporated, 40 Court St, Suite 300, Boston, MA, 02108, USA
| | - Matthew Menear
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, CHU de Québec, 10 de l'Espinay, Quebec, QC, G1V 0A6, Canada
| | - Jean-Sébastien Renaud
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Dawn Stacey
- School of Nursing and Ottawa Hospital Research Institute, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77230, USA
| | - Holly O Witteman
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
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11
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Saraswat M, Bezuhly M, Hanly J, Issekutz T, Johnston B, Lin T, Marshall J, McDougall J, Légaré J. RECOVERY FREE OF HEART FAILURE AFTER POST-ACS CABG: TOWARDS A BETTER UNDERSTANDING OF THE BIOLOGICAL MECHANISM FAVOURING RESOLUTION OF INFLAMMATION. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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12
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Witteman HO, Dansokho SC, Colquhoun H, Coulter A, Dugas M, Fagerlin A, Giguere AM, Glouberman S, Haslett L, Hoffman A, Ivers N, Légaré F, Légaré J, Levin C, Lopez K, Montori VM, Provencher T, Renaud JS, Sparling K, Stacey D, Vaisson G, Volk RJ, Witteman W. User-centered design and the development of patient decision aids: protocol for a systematic review. Syst Rev 2015; 4:11. [PMID: 25623074 PMCID: PMC4328638 DOI: 10.1186/2046-4053-4-11] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 12/29/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Providing patient-centered care requires that patients partner in their personal health-care decisions to the full extent desired. Patient decision aids facilitate processes of shared decision-making between patients and their clinicians by presenting relevant scientific information in balanced, understandable ways, helping clarify patients' goals, and guiding decision-making processes. Although international standards stipulate that patients and clinicians should be involved in decision aid development, little is known about how such involvement currently occurs, let alone best practices. This systematic review consisting of three interlinked subreviews seeks to describe current practices of user involvement in the development of patient decision aids, compare these to practices of user-centered design, and identify promising strategies. METHODS/DESIGN A research team that includes patient and clinician representatives, decision aid developers, and systematic review method experts will guide this review according to the Cochrane Handbook and PRISMA reporting guidelines. A medical librarian will hand search key references and use a peer-reviewed search strategy to search MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, the ACM library, IEEE Xplore, and Google Scholar. We will identify articles across all languages and years describing the development or evaluation of a patient decision aid, or the application of user-centered design or human-centered design to tools intended for patient use. Two independent reviewers will assess article eligibility and extract data into a matrix using a structured pilot-tested form based on a conceptual framework of user-centered design. We will synthesize evidence to describe how research teams have included users in their development process and compare these practices to user-centered design methods. If data permit, we will develop a measure of the user-centeredness of development processes and identify practices that are likely to be optimal. DISCUSSION This systematic review will provide evidence of current practices to inform approaches for involving patients and other stakeholders in the development of patient decision aids. We anticipate that the results will help move towards the establishment of best practices for the development of patient-centered tools and, in turn, help improve the experiences of people who face difficult health decisions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014013241.
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Affiliation(s)
- Holly O Witteman
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, Quebec City, QC G1V 0A6, Canada.
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13
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Roussy JP, Bessette L, Rahme E, Bernatsky S, Légaré J, Lachaine J. Rheumatoid arthritis pharmacotherapy and predictors of disease-modifying anti-rheumatic drug initiation in the early years of biologic use in Quebec, Canada. Rheumatol Int 2013; 34:75-83. [PMID: 23959574 DOI: 10.1007/s00296-013-2828-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
Disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of rheumatoid arthritis (RA) pharmacotherapy and should be initiated promptly after RA diagnosis. We examined trends in use of traditional and biologic DMARDs, and non-DMARD treatments, among overall RA patients, and factors associated with DMARD initiation in the newly diagnosed RA. RA subjects identified with the Quebec administrative databases were followed between January 1, 2002, and December 31, 2008. DMARD use was characterized on November 1 of each year using cross-sectional analyses. For a subgroup of newly diagnosed subjects, we used multivariable logistic regressions to identify predictors of DMARD initiation within 12 months of diagnosis and survival analyses to appraise time to DMARD initiation. A total of 37,399 subjects were included (65.8 % ≥65 years; 70.5 % female). The percentage of subjects using any DMARDs increased over the study period from 41.4 % [95 % confidence interval (CI) 40.8-42.0] to 43.3 % (95 % CI 42.7-43.9). Among newly diagnosed RA, being followed by a rheumatologist was the strongest predictor of DMARD initiation (odds ratio 4.31; 95 % CI 3.73-4.97). Care by an internist, increasing calendar year, use of NSAIDs, corticosteroids, or opioids, and a history of hospitalization increased the likelihood of DMARD initiation. Older age, female, higher comorbidity score, number of medical visits pre-diagnosis, care by other specialists, and the use of acetaminophen were inversely associated with DMARD initiation. The probability of any DMARD initiation at 12 months was 38.5 %. Despite the clinical practice guideline recommendations for earlier aggressive RA management, DMARD use appears to be suboptimal in Quebec.
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Affiliation(s)
- Jean-Pascal Roussy
- Faculty of Pharmacy, University of Montreal, Pavillon Jean-Coutu, 2940 Chemin de la polytechnique, Office 2252, Montreal, QC, H3C 3J7, Canada,
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14
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Légaré F, Moumjid-Ferdjaoui N, Drolet R, Stacey D, Härter M, Bastian H, Beaulieu MD, Borduas F, Charles C, Coulter A, Desroches S, Friedrich G, Gafni A, Graham ID, Labrecque M, LeBlanc A, Légaré J, Politi M, Sargeant J, Thomson R. Core competencies for shared decision making training programs: insights from an international, interdisciplinary working group. J Contin Educ Health Prof 2013; 33:267-73. [PMID: 24347105 PMCID: PMC3911960 DOI: 10.1002/chp.21197] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Shared decision making is now making inroads in health care professionals' continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training.
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Affiliation(s)
- France Légaré
- CHUQ Research Centre, Hôpital St-François D'Assise, 10 rue Espinay, Québec QC G1L 3L5, Canada;.
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15
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Launcelott S, Ouzounian M, Buth K, Légaré J. 111 Development of a Novel Scorecard Predicting In-Hospital Mortality Following Redo Cardiac Surgery. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Rosin N, Sopel M, Falkenham A, Myers T, Lee T, Légaré J. 369 The Effects of Aging on Myocardial Fibrosis Development Secondary to Angiotensinii Exposure. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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17
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Bombardier C, Hazlewood GS, Akhavan P, Schieir O, Dooley A, Haraoui B, Khraishi M, Leclercq SA, Légaré J, Mosher DP, Pencharz J, Pope JE, Thomson J, Thorne C, Zummer M, Gardam MA, Askling J, Bykerk V. Canadian Rheumatology Association recommendations for the pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs: part II safety. J Rheumatol 2012; 39:1583-602. [PMID: 22707613 DOI: 10.3899/jrheum.120165] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of rheumatoid arthritis (RA) with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in 2 parts. Part II, focusing on specific safety aspects of treatment with traditional and biologic DMARD in patients with RA, is reported here. METHODS Key questions were identified a priori based on results of a national needs-assessment survey. A systematic review of all clinical practice guidelines and consensus statements regarding treatment with traditional and biologic DMARD in patients with RA published between January 2000 and June 2010 was performed in Medline, Embase, and CINAHL databases, and was supplemented with a "grey literature" search including relevant public health guidelines. Systematic reviews of postmarketing surveillance and RA registry studies were performed to update included guideline literature reviews as appropriate. Guideline quality was independently assessed by 2 reviewers. Guideline characteristics, recommendations, and supporting evidence from observational studies and randomized trials were synthesized into evidence tables. The working group voted on recommendations using a modified Delphi technique. RESULTS Thirteen recommendations addressing perioperative care, screening for latent tuberculosis infection prior to the initiation of biologic DMARD, optimal vaccination practices, and treatment of RA patients with active or a history of malignancy were developed for rheumatologists, other primary prescribers of RA drug therapies, and RA patients. CONCLUSION These recommendations were developed based on a synthesis of international RA and public health guidelines, supporting evidence, and expert consensus in the context of the Canadian health system. They are intended to help promote best practices and improve healthcare delivery for persons with RA.
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Affiliation(s)
- Claire Bombardier
- The Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, Canada.
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18
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Légaré F, Boivin A, van der Weijden T, Pakenham C, Burgers J, Légaré J, St-Jacques S, Gagnon S. Patient and Public Involvement in Clinical Practice Guidelines. Med Decis Making 2011; 31:E45-74. [DOI: 10.1177/0272989x11424401] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. The role of patient and public involvement programs (PPIPs) in developing and implementing clinical practice guidelines (CPGs) has generated great interest. Purpose. The authors sought to identify key components of PPIPs used in developing and implementing CPGs. Data sources. The authors searched bibliographic databases and contacted relevant organizations. Study selection. In total, 2161 articles and reports were retrieved on PPIPs in the development and implementation of CPGs. Of these, 71 qualified for inclusion in the review. Data extraction. Reviewers independently extracted data on key components of PPIPs and barriers and facilitators to their operation. Data synthesis. Over half of the studies were published after 2002, and more than half originated from the United States, the United Kingdom, Australia, and Germany. CPGs that involved patients and the public addressed a variety of health problems, especially mental health and cancer. The most frequently cited objective for using PPIPs in developing CPGs was to incorporate patients’ values or perspectives in CPG recommendations. Patients and their families and caregivers were the parties most often involved. Methods used to recruit PPIP participants included soliciting through patient/public organizations, sending invitations, and receiving referrals and recruits from clinicians. Patients and the public most often participated by taking part in a CPG working group, workshop, meeting, seminar, literature review, or consultation such as a focus group, individual interview, or survey. Patients and the public principally helped formulate recommendations and revise drafts. Limitations. The authors did not contact the authors of the studies. Conclusion. This literature review provides an extensive knowledge base for making PPIPs more effective when developing and implementing CPGs. More research is needed to assess the impact of PPIPs and resources they require.
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Affiliation(s)
- France Légaré
- Canada Research Chair in Implementation of Shared Decision-Making in Primary Care, Université Laval, Québec City, Québec, Canada (FL)
- Research Center, Centre Hospitalier Universitaire de Québec (FL, SG)
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (AB, JB)
- Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, the Netherlands (TVW)
- Ministère de la santé et des Services Sociaux de Québec, Québec, Québec, Canada (CP)
| | - Antoine Boivin
- Canada Research Chair in Implementation of Shared Decision-Making in Primary Care, Université Laval, Québec City, Québec, Canada (FL)
- Research Center, Centre Hospitalier Universitaire de Québec (FL, SG)
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (AB, JB)
- Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, the Netherlands (TVW)
- Ministère de la santé et des Services Sociaux de Québec, Québec, Québec, Canada (CP)
| | - Trudy van der Weijden
- Canada Research Chair in Implementation of Shared Decision-Making in Primary Care, Université Laval, Québec City, Québec, Canada (FL)
- Research Center, Centre Hospitalier Universitaire de Québec (FL, SG)
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (AB, JB)
- Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, the Netherlands (TVW)
- Ministère de la santé et des Services Sociaux de Québec, Québec, Québec, Canada (CP)
| | - Christine Pakenham
- Canada Research Chair in Implementation of Shared Decision-Making in Primary Care, Université Laval, Québec City, Québec, Canada (FL)
- Research Center, Centre Hospitalier Universitaire de Québec (FL, SG)
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (AB, JB)
- Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, the Netherlands (TVW)
- Ministère de la santé et des Services Sociaux de Québec, Québec, Québec, Canada (CP)
| | - Jako Burgers
- Canada Research Chair in Implementation of Shared Decision-Making in Primary Care, Université Laval, Québec City, Québec, Canada (FL)
- Research Center, Centre Hospitalier Universitaire de Québec (FL, SG)
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (AB, JB)
- Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, the Netherlands (TVW)
- Ministère de la santé et des Services Sociaux de Québec, Québec, Québec, Canada (CP)
| | - Jean Légaré
- Canada Research Chair in Implementation of Shared Decision-Making in Primary Care, Université Laval, Québec City, Québec, Canada (FL)
- Research Center, Centre Hospitalier Universitaire de Québec (FL, SG)
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (AB, JB)
- Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, the Netherlands (TVW)
- Ministère de la santé et des Services Sociaux de Québec, Québec, Québec, Canada (CP)
| | - Sylvie St-Jacques
- Canada Research Chair in Implementation of Shared Decision-Making in Primary Care, Université Laval, Québec City, Québec, Canada (FL)
- Research Center, Centre Hospitalier Universitaire de Québec (FL, SG)
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (AB, JB)
- Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, the Netherlands (TVW)
- Ministère de la santé et des Services Sociaux de Québec, Québec, Québec, Canada (CP)
| | - Susie Gagnon
- Canada Research Chair in Implementation of Shared Decision-Making in Primary Care, Université Laval, Québec City, Québec, Canada (FL)
- Research Center, Centre Hospitalier Universitaire de Québec (FL, SG)
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands (AB, JB)
- Department of General Practice, School for Public Health and Primary Care (Caphri), Maastricht University, Maastricht, the Netherlands (TVW)
- Ministère de la santé et des Services Sociaux de Québec, Québec, Québec, Canada (CP)
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Bykerk VP, Akhavan P, Hazlewood GS, Schieir O, Dooley A, Haraoui B, Khraishi M, Leclercq SA, Légaré J, Mosher DP, Pencharz J, Pope JE, Thomson J, Thorne C, Zummer M, Bombardier C. Canadian Rheumatology Association recommendations for pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs. J Rheumatol 2011; 39:1559-82. [PMID: 21921096 DOI: 10.3899/jrheum.110207] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Canadian Rheumatology Association (CRA) has developed recommendations for the pharmacological management of rheumatoid arthritis (RA) with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in 2 parts. Part 1 is reported here. METHODS The CRA Therapeutics Committee assembled a national working group of RA clinical experts, researchers, patient consumers, and a general practitioner. Treatment questions were developed a priori based on results of a national needs assessment survey. A systematic review of all clinical practice guidelines and consensus statements regarding treatment with traditional and biologic DMARD in patients with RA published between January 2000 and June 2010 was performed in Medline, Embase, and CINAHL databases, and the grey literature. Guideline quality was assessed by 2 independent reviewers, and guideline characteristics, recommendations, and supporting evidence from observational studies and randomized controlled trials were synthesized into evidence tables. The full working group reviewed the evidence tables and developed recommendations using a modified Delphi technique. RESULTS Five overarching principles and 26 recommendations addressing general RA management strategies and treatment with glucocorticoids and traditional and biologic DMARD were developed for rheumatologists, other primary prescribers of RA drug therapies, and patients with RA. CONCLUSION These recommendations were developed based on a synthesis of international guidelines, supporting evidence, and expert consensus considering the Canadian healthcare context with the intention of promoting best practices and improving healthcare delivery for persons with RA.
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Affiliation(s)
- Vivian P Bykerk
- Mount Sinai Hospital, The Rebecca McDonald Centre for Arthritis and Autoimmune Disease, Toronto, Canada.
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Sopel M, Rosin N, Falkenham A, Myers T, Lee T, Légaré J. 150 Myocardial fibrosis secondary to angiotensin II exposure is hypertension dependent. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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21
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Horwich P, Buth K, Légaré J. 476 New onset post-operative atrial fibrillation is associated with a long-term risk for stroke following cardiac surgery. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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22
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Leontyev S, Légaré J, Borger M, Buth K, Funkat A, Gerhard J, Lehmann S, Seeburger J, Mohr F. 366 Predictors for in hospital mortality in patients with type a aortic dissection from a two centre experience. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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23
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Herman C, Buth K, Légaré J, Levy A, Baskett R. 619 Do intra-operative precursor events impact post-operative outcomes? Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Normandeau L, Légaré J. [Not Available]. Can Rev Sociol Anthropol 2001; 16:260-74. [PMID: 11630777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Trottier H, Martel L, Houle C, Berthelot JM, Légaré J. Living at home or in an institution: what makes the difference for seniors? Health Rep 2001; 11:49-61 (Eng); 55-68 (Fre). [PMID: 10879330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES This article examines some of the health and socio-demographic factors associated with living in long-term health care facilities rather than in private households, for elderly people with various levels of disability. DATA SOURCE The data are from the 1996/97 National Population Health Survey conducted by Statistics Canada. Data from a sample of 1,711 people aged 65 or older living in long-term health care facilities and 13,363 in private households were weighted to represent about 185,100 and 3.4 million seniors, respectively. ANALYTICAL TECHNIQUES Descriptive data were produced using bivariate frequencies. Multiple logistic regression models were used to examine associations between living in long-term health care facilities and selected health and socio-demographic characteristics for seniors with self-reported severe, moderate or no disability. MAIN RESULTS While health status was strongly associated with residence in a long-term health care facility, the absence of a spouse, low income, low education, and advanced age were also significant.
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Nonaka K, Desjardins B, Charbonneau H, Légaré J, Miura T. Human sex ratio at birth and mother's birth season: multivariate analysis. Hum Biol 1999; 71:875-84. [PMID: 10510576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
We used a population-based historical French Canadian database to examine the effects of mother's birth season on sex ratio at birth. Non-first births in the database (n = 127,658) were analyzed for their sex, parish size (2 large parishes of Montreal and Quebec or the other smaller parishes), time period (births up to 1719 or those from 1720), maternal age (< or = 24, 25-29, 30-34, 35+ years), sex of the preceding sibling (male or female), and birth seasons of the child and his or her parents (February-April, May-July, August-October, November-January). Season of child's birth significantly affected the sex ratio (chi 2 = 11.507, d.f. = 3, p = 0.009), with the births in February-April or May-July showing a lower sex ratio. Season of mother's birth also contributed highly significantly to the variation of sex ratio (chi 2 = 15.196, d.f. = 3, p = 0.002); mothers born in February-April had a low sex ratio among their children (sex ratio = 1.013). In contrast, season of father's birth did not affect the sex ratio (chi 2 = 0.618, d.f. = 3, p = 0.892). When a multiple logistic model was applied to the data, mother's birth season was the single most significant factor. The lower sex ratio from mothers born in February-April was observed consistently for every maternal age and delivery season. Seasonal influences on female fetuses seem to have changed their future reproductive characteristics.
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Affiliation(s)
- K Nonaka
- Department of Hygiene, Teikyo University School of Medicine, Tokyo, Japan
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Beaulieu MD, Hudon E, Roberge D, Pineault R, Forté D, Légaré J. Practice guidelines for clinical prevention: do patients, physicians and experts share common ground? CMAJ 1999; 161:519-23. [PMID: 10497607 PMCID: PMC1230580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Clinical practice guidelines, such as those of the Canadian Task Force on Preventive Health Care, although based on sound evidence, may conflict with the perceived needs and expectations of patients and physicians. This may jeopardize the implementation of such guidelines. This study was undertaken to explore patients' and family physicians' acceptance of the task force's recommendations and the values and criteria upon which the opinions of these 2 groups are based. METHODS Focus groups were used to collect study data. In total, 35 physicians (in 7 groups) and 75 patient representatives (in 9 groups) participated in the focus groups. An inductive approach was used to develop coding grids and to generate themes from the transcripts of the interviews. RESULTS Physicians expressed resistance to discontinuing the annual check-up, which they viewed as an organizational strategy to counteract the many barriers to preventive care that they encounter. They reported difficulties in explaining to their patients the recommendations of the Canadian Task Force on Preventive Health Care, which they found complex and inconsistent with popular wisdom. Both patients and physicians attributed high value to the detection of insidious diseases, even in the absence of proof of the effectiveness of such activity. INTERPRETATION The patients and family physicians who participated in this study shared many opinions on the value of preventive activities that depart from the values used by "prevention experts" such as the Canadian Task Force on Preventive Health Care in establishing their recommendations. A better understanding of the values of patients and physicians would help guideline developers to create better targeted communication strategies to take these discrepancies into account.
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Affiliation(s)
- M D Beaulieu
- Department of Family Medicine, Université de Montréal, Que
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Nonaka K, Desjardins B, Charbonneau H, Légaré J, Miura T. Marriage season, promptness of successful pregnancy and first-born sex ratio in a historical natural fertility population--evidence for sex-dependent early pregnancy loss? Int J Biometeorol 1998; 42:89-92. [PMID: 9923201 DOI: 10.1007/s004840050090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We investigated population-based vital records of the seventeenth and eighteenth century French Canadian population to assess the effects of marriage season on the outcome of the first births under natural fertility conditions (n = 21,698 marriages). Promptness of the first successful conception after marriage differed according to marriage season; the proportion of marriages with a marriage-first birth interval of 8.0-10.0 months was lowest (34%) for marriages in August-October (P = 0.001). Although the male/female sex ratio of the babies born with an interval of 8.0-10.0 months was generally higher (1.10) than those with an interval of 10.0-24.0 months (1.05), the marriages in August-October resulted in a significantly reduced sex ratio (0.96) among only the prompt conceptions (P = 0.026). We discuss whether this seasonal reduction of the sex ratio could be partly explained by a clustered pregnancy loss of male zygotes in early pregnancy.
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Affiliation(s)
- K Nonaka
- Department of Hygiene, Teikyo University School of Medicine, Tokyo, Japan
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Abstract
BACKGROUND Cigarette smoking is the No. 1 cause of premature death among Canadians. However, tobacco consumption dropped by 35% in Canada during the 1980s. METHODS Using data collected during a Quebec health survey, we evaluated the prevalences of tobacco use by birth cohort. Since mortality has been decreasing for both sexes, we computed gender-specific cohort mortality indices for tobacco-related causes of death. In the analysis, we took into account the inevitable time lag between adopting the behavior and becoming the victim of a smoking-attributable disease. RESULTS Results indicate a systematic decrease in tobacco use from older male cohorts to younger ones across all ages; however, for females an increase in tobacco use has been observed from one cohort to the next but there seems to be hope for a future trend toward breaking the habit. While a decline in tobacco-related mortality has been observed among men (e.g., death from ischemic heart disease), female lung cancer mortality increased considerably. Finally, we present an indicator measuring the years of potential life lost for some tobacco-related causes of death. CONCLUSIONS The cohort approach allows us to observe birth-cohort-specific trends, thereby more easily relating past behavior to current mortality levels. In terms of prevention, increasing female mortality from lung cancer should become a major concern and a motivator in the fight against tobacco use.
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Affiliation(s)
- F Pelletier
- Département de démographie, Université de Montréal, Québec, Canada
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Nonaka K, Desjardins B, Charbonneau H, Légaré J, Miura T. Slow twin conception at first birth and subsequent maternal twin proneness in a natural fertility population. Acta Genet Med Gemellol (Roma) 1995; 44:215-22. [PMID: 8739733 DOI: 10.1017/s000156600000163x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
To study whether apparently more fecund women having delivered twins at first birth have traits of higher twin-proneness, we performed a retrospective cohort study on population-based historical vital records of the 17-18th century French Canadian immigrants and their descendants under natural fertility conditions. Among 24896 mothers who had at least one child, 248 had twin maternities at their first birth (twinning rate = 1.0%). Among 21508 mothers with a valid marriage-first birth interval, twinning rate was 0.97% among prompt conceptions (7.0-11.0 months), with a particularly high rate at the interval of 7.0-8.0 months (2.2%). Marriages in August-October resulted in a higher twinning rate particularly for the slow conceptions than those in the other seasons. Promptly-conceived mothers of twins at the first delivery may seem to have higher fecundity, but subsequent births from these mothers (n = 88) show a lower twinning rate (1.7%) particularly at younger maternal age than from the other mothers who had slowly conceived twins at their first birth (n = 112). The latter show a 4.5% twinning rate as a whole among their second or later births. So-called twin-proneness of a mother, whether genetic or acquired, was not connected to higher conception rate of twin's mothers immediately after marriage. Reduced fecundity, which may have been imposed by some environmental factors, could raise the chance of twinning.
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Affiliation(s)
- K Nonaka
- Department of Hygiene, Teikyo University School of Medicine, Tokyo, Japan
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31
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Le Bourg E, Thon B, Légaré J, Desjardins B, Charbonneau H. Reproductive life of French-Canadians in the 17-18th centuries: a search for a trade-off between early fecundity and longevity. Exp Gerontol 1993; 28:217-32. [PMID: 8344394 DOI: 10.1016/0531-5565(93)90030-h] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
One of the predictions derived from Williams' (1957) evolutionary theory of senescence is the existence of a trade-off between early fecundity and longevity. The population register of the French immigrants to Québec in the 17th century and of the first Canadians in the 17th and 18th centuries was used to detect such a trade-off in a noncontraceptive human population living at a time when longevity had not been prolonged by medical care and was not artificially shortened by wars, epidemics, or other external causes. No evidence for such a trade-off could be detected in these populations which had not yet reached the demographic transition phase (i.e., the historical period when longevity began to be extended and the progeny began to be reduced). Results are discussed in connection with the various studies aiming to test the Williams' theory.
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Affiliation(s)
- E Le Bourg
- Université Paul Sabatier, U.R.A. C.N.R.S. 664, Toulouse, France
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Nonaka K, Desjardins B, Légaré J, Charbonneau H, Miura T. Effects of maternal birth season on birth seasonality in the Canadian population during the seventeenth and eighteenth centuries. Hum Biol 1990; 62:701-17. [PMID: 2227914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Birth records of the French-Canadian population for the period 1621-1765 were analyzed retrospectively to examine the effect of maternal birth season on the seasonal distribution of births. Preliminary examination indicated that there was a bimodal pattern in birth seasonality: a major peak in early spring, a trough in early summer, a minor peak in autumn, and a trough around December. Because this seasonality was strongly biased at the level of the first birth by the month of marriage, which was concentrated in November, the seasonality of nonfirst births (n = 32,926) was examined in relation to the four seasons of maternal birth. Mothers born in May-July showed a flatter monthly distribution of nonfirst births at a maternal age of 28 years or more. Analysis of marriage-first birth intervals indicated that mothers who married in August-October showed a lower percentage of immediate conception (intervals of 8-10 months), whereas those mothers born in May-July had a higher percentage of immediate conception. This difference in birth seasonality shown by mothers born in May-July is similar to results from early twentieth-century Japan. Some seasonal infertility factors could have affected the embryos at the earliest stage of pregnancy, modifying a part of the seasonal variation in birth rate.
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Affiliation(s)
- K Nonaka
- Department of Hygiene, Teikyo University School of Medicine, Tokyo, Japan
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Affiliation(s)
- J Légaré
- Département de Démographie, Faculté des Arts et des Sciences, Université de Montréal, Québec, Canada
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Nault F, Desjardins B, Légaré J. Effects of reproductive behaviour on infant mortality of French-Canadians during the seventeenth and eighteenth centuries. Popul Stud (Camb) 1990; 44:273-85. [PMID: 11622323 DOI: 10.1080/0032472031000144596] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nault F, Boleda M, Légaré J. [Not Available]. Population (Paris) 1986; 41:749-762. [PMID: 21213867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Desjardins B, Beauchamp P, Légaré J. Automatic family reconstitution: the French-Canadian seventeenth-century experience. J Fam Hist 1977; 2:56-76. [PMID: 11610103 DOI: 10.1177/036319907700200103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Légaré J. Methods for measuring school performance through cohort analysis. Demography 1972; 9:617-24. [PMID: 4670346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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